{{ header }}
<div id="account-voucher" class="container">
  <ul class="breadcrumb">
    {% for breadcrumb in breadcrumbs %}
      <li class="breadcrumb-item"><a href="{{ breadcrumb.href }}">{{ breadcrumb.text }}</a></li>
    {% endfor %}
  </ul>
  {% if error_warning %}
    <div class="alert alert-danger alert-dismissible"><i class="fas fa-exclamation-circle"></i> {{ error_warning }}</div>
  {% endif %}
  <div class="row">{{ column_left }}
    <div id="content" class="col">{{ content_top }}
      <h1>{{ heading_title }}</h1>
      <p>{{ text_description }}</p>
      <form action="{{ action }}" method="post" enctype="multipart/form-data">
        <div class="form-group row required">
          <label class="col-sm-2 col-form-label" for="input-to-name">{{ entry_to_name }}</label>
          <div class="col-sm-10">
            <input type="text" name="to_name" value="{{ to_name }}" id="input-to-name" class="form-control"/>
            {% if error_to_name %}
              <div class="text-danger">{{ error_to_name }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group row required">
          <label class="col-sm-2 col-form-label" for="input-to-email">{{ entry_to_email }}</label>
          <div class="col-sm-10">
            <input type="text" name="to_email" value="{{ to_email }}" id="input-to-email" class="form-control"/>
            {% if error_to_email %}
              <div class="text-danger">{{ error_to_email }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group row required">
          <label class="col-sm-2 col-form-label" for="input-from-name">{{ entry_from_name }}</label>
          <div class="col-sm-10">
            <input type="text" name="from_name" value="{{ from_name }}" id="input-from-name" class="form-control"/>
            {% if error_from_name %}
              <div class="text-danger">{{ error_from_name }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group row required">
          <label class="col-sm-2 col-form-label" for="input-from-email">{{ entry_from_email }}</label>
          <div class="col-sm-10">
            <input type="text" name="from_email" value="{{ from_email }}" id="input-from-email" class="form-control"/>
            {% if error_from_email %}
              <div class="text-danger">{{ error_from_email }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group row required">
          <label class="col-sm-2 col-form-label">{{ entry_theme }}</label>
          <div class="col-sm-10">
            {% for voucher_theme in voucher_themes %}
              {% if voucher_theme.voucher_theme_id == voucher_theme_id %}
                <div class="form-check">
                  <label> <input type="radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" class="form-check-input" checked="checked"/>
                    {{ voucher_theme.name }}</label>
                </div>
              {% else %}
                <div class="form-check">
                  <label><input type="radio" name="voucher_theme_id" value="{{ voucher_theme.voucher_theme_id }}" class="form-check-input"/>
                    {{ voucher_theme.name }}</label>
                </div>
              {% endif %}
            {% endfor %}
            {% if error_theme %}
              <div class="text-danger">{{ error_theme }}</div>
            {% endif %}
          </div>
        </div>
        <div class="form-group row">
          <label class="col-sm-2 col-form-label" for="input-message"><span data-toggle="tooltip" title="{{ help_message }}">{{ entry_message }}</span></label>
          <div class="col-sm-10">
            <textarea name="message" cols="40" rows="5" id="input-message" class="form-control">{{ message }}</textarea>
          </div>
        </div>
        <div class="form-group row">
          <label class="col-sm-2 col-form-label" for="input-amount"><span data-toggle="tooltip" title="{{ help_amount }}">{{ entry_amount }}</span></label>
          <div class="col-sm-10">
            <input type="text" name="amount" value="{{ amount }}" id="input-amount" class="form-control" size="5"/>
            {% if error_amount %}
              <div class="text-danger">{{ error_amount }}</div>
            {% endif %}
          </div>
        </div>
        <div class="d-inline-block pt-2 pd-2 w-100">
          <div class="float-right"> {{ text_agree }}
            {% if agree %}
              <input type="checkbox" name="agree" value="1" checked="checked"/>
            {% else %}
              <input type="checkbox" name="agree" value="1"/>
            {% endif %}
            &nbsp;
            <button type="submit" class="btn btn-primary">{{ button_continue }}</button>
          </div>
        </div>
      </form>
      {{ content_bottom }}</div>
    {{ column_right }}</div>
</div>
{{ footer }}
